BACKGROUND: In Kansas, five vaccine series are required for school entry. Kansas statute specifies that students that are not in compliance with vaccination requirements may be excluded from school until such time when requirements are met. School boards have the authority to enforce this statute and enforcement is variable. The objective of this study was to determine the impact of school exclusion policy on vaccination coverage among Kansas kindergarteners.
METHODS: A stratified random sample of vaccination records for kindergartners was collected for the 2014-2015 academic year. Sampling weights were calculated based on county and school type (public and private). Schools were surveyed about policies for excluding children not in compliance. Vaccination coverage was analyzed to determine compliance with vaccination requirements at both school entry and 30 days after school entry for each of the five vaccine series required for entry into kindergarten (4 or 5 doses of DTaP (DTAP5), 4 doses of Polio (IPV4), 2 doses of MMR (MMR2), 2 doses of Varicella (VAR2), and 3 doses of Hepatitis B (HEPB3)). Vaccination coverage was stratified by school exclusion policy.
RESULTS: Vaccination records were requested from 414 schools; 389 schools responded (94%) submitting 9,219 vaccination records. Of the responding schools, 224 (58%) reported excluding children who were not compliant with vaccination requirements. Schools that excluded non-compliant children had significantly higher vaccination coverage for all five required vaccines (DTAP5 88.6%, IPV4 89.0%, MMR2 88.8%, VAR2 88.4% and HEPB3 96.9%) when compared to schools that did not exclude (DTAP5 86.8%, IPV4 87.8%, MMR2 86.6%, VAR2 85.1%, and HEPB3: 95.9%). The percentage of children who were fully vaccinated with all required vaccines was also significantly higher in schools that excluded non-compliant children, 83.4% compared to 80.3%. Vaccination coverage for DTAP5, IPV4, MMR2, and VAR2 increased in all schools in the 30 days following school entry but the increase was greater in schools with exclusion policies. HEPB3 vaccination coverage did not increase in schools regardless of exclusion policies; however, the percentage of children who were compliant for all required vaccines significantly increased in schools with exclusion policies 30 days following the start of school, 3.8% compared to 1.2%.
CONCLUSIONS: Significantly higher vaccination coverage levels were observed in schools that exclude children who are non-compliant. Lower vaccination coverage among kindergarteners may increase the risk for vaccine-preventable disease transmission within school settings. Encouraging or mandating schools to exclude non-compliant children may further increase coverage rates for vaccinations required for school entry.